Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 11 de 11
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Nurs Res ; 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38773838

RESUMO

BACKGROUND: For years, nurse researchers have been called upon to engage with "big data" in the electronic health record (EHR) by leading studies focusing on nurse-centric patient outcomes and providing clinical analysis of potential outcome indicators. However, the current gap in nurses' data science education and training pose a significant barrier. OBJECTIVES: We aimed to evaluate the viability of conducting nurse-led, big-data research projects within a custom-designed computational lab and examine the support required by a team of researchers with little to no big-data experience. METHODS: Four nurse-led research teams developed a research question reliant on existing EHR data. Each team was given its own virtual computational lab populated with raw data. A data science education team provided instruction in coding languages-primarily structured query language and R-and data science techniques to organize and analyze the data. RESULTS: Three research teams have completed studies, resulting in one manuscript currently undergoing peer-review and two manuscripts in progress. The final team is performing data analysis. Four barriers and four facilitators to big-data projects were identified. DISCUSSION: As the data-science learning curve is steep, organizations need to help bridge the gap between what is currently taught in doctoral nursing programs and what is required of clinical nurse researchers to successfully engage in big-data methods. Additionally, clinical nurse researchers require protected research time and a data science infrastructure that supports novice efforts with education, mentorship, and computational lab resources.

2.
J Emerg Nurs ; 50(2): 207-214, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38099907

RESUMO

INTRODUCTION: Although the Emergency Severity Index is the most widely used tool in the United States to prioritize care for patients who seek emergency care, including children, there are significant deficiencies in the tool's performance. Inaccurate triage has been associated with delayed treatment, unnecessary diagnostic testing, and bias in clinical care. We evaluated the accuracy of the Emergency Severity Index to stratify patient priority based on predicted resource utilization in pediatric emergency department patients and identified covariates influencing performance. METHODS: This cross-sectional, retrospective study used a data platform that links clinical and research data sets from a single freestanding pediatric hospital in the United States. Chi-square analysis was used to describes rates of over- and undertriage. Mixed effects ordinal logistic regression identified associations between Emergency Severity Index categories assigned at triage and key emergency department resources using discrete data elements and natural language processing of text notes. RESULTS: We analyzed 304,422 emergency department visits by 153,984 unique individuals in the final analysis; 80% of visits were triaged as lower acuity Emergency Severity Index levels 3 to 5, with the most common level being Emergency Severity Index 4 (43%). Emergency department visits scored Emergency Severity Index levels 3 and 4 were triaged accurately 46% and 38%, respectively. We noted racial differences in overall triage accuracy. DISCUSSION: Although the plurality of patients was scored as Emergency Severity Index 4, 50% were mistriaged, and there were disparities based on race indicating Emergency Severity Index mistriages pediatric patients. Further study is needed to elucidate the application of the Emergency Severity Indices in pediatrics using a multicenter emergency department population with diverse clinical and demographic characteristics.


Assuntos
Serviços Médicos de Emergência , Triagem , Humanos , Criança , Estados Unidos , Estudos Retrospectivos , Estudos Transversais , Serviço Hospitalar de Emergência , Índice de Gravidade de Doença
3.
Nurse Educ Today ; 100: 104862, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33799085

RESUMO

BACKGROUND: There is a paucity of research describing burnout among nurses who work in the role of a preceptor, in the inpatient setting. In 2017, precepting nurses at an academic children's hospital were surveyed using the Oldenburg Burnout Inventory (OBI). Results of the survey inspired leadership to further explore this phenomenon using key informant interviews. METHODS: Prospective qualitative description with individual interviews analyzed using conventional content analysis. RESULTS: In regard to burnout, five themes illustrated the experiences of precepting nurses. "Feeling the Responsibility" reflected the cognitive stain of precepting. "An Obligation to the Role," reflected the dimensions of the OBI that addressed distancing and decreased interest in the work. However, preceptors described positive experiences "It Challenges Me Every Day," awareness of resources "Nursing Response," and insights for improving the preceptor program, "Future Strategies." CONCLUSIONS: While elements of the OBI were salient in the data, three inductive themes highlighted the balance of positive challenges and learning opportunities that inspire preceptors.


Assuntos
Esgotamento Profissional , Pacientes Internados , Criança , Humanos , Enfermagem Pediátrica , Preceptoria , Estudos Prospectivos
4.
J Clin Nurs ; 30(1-2): 200-206, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33090594

RESUMO

AIMS AND OBJECTIVES: To evaluate differences in hospitals' proportion of specialty certified nurses and to determine whether and to what extent individual nurse characteristics and organisational hospital characteristics are associated with a nurse's likelihood of having specialty certification. BACKGROUND: Prior research has shown that patients in hospitals with high proportions of specialty certified nurses have better outcomes including lower mortality and fewer adverse events, yet less is known about what motivates nurses to obtain specialty certification. METHODS AND DESIGN: Cross-sectional study of paediatric nurses in 119 acute care hospitals. Multivariate logistic regression models were used to determine the association between individual nurse characteristics, organisational hospital characteristics and an individual nurses' likelihood of holding a specialty certification. STROBE was followed. RESULTS: The proportion of certified nurses varies substantially among hospitals, with Magnet® hospitals being significantly more likely, on average, to have higher proportions of certified nurses. Nurses in children's hospitals were no more likely than paediatric nurses in general hospitals to be certified. A nurse's years of experience and bachelors-preparation were significantly associated with higher odds of having certification. The strongest predictors of certification were favourable nurse work environments and Magnet® -designation of the hospital. CONCLUSIONS: While individual attributes of the nurse were associated with a nurse's likelihood of having a specialty certification, the strongest predictors of certification were modifiable attributes of the hospital-a favourable nurse work environment and Magnet® -designation. RELEVANCE TO CLINICAL PRACTICE: Hospital administrators seeking to increase the proportion of specialty certified nurses in their organisation should look to improvements in the organisation's nurse work environment as a possible mechanism.


Assuntos
Enfermeiros Pediátricos , Recursos Humanos de Enfermagem Hospitalar , Certificação , Criança , Estudos Transversais , Feminino , Hospitais Pediátricos , Humanos , Local de Trabalho
5.
J Patient Saf ; 17(8): e1546-e1552, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30601233

RESUMO

OBJECTIVES: Eighteen years ago, the Institute of Medicine estimated that medical errors in hospital were a major cause of mortality. Since that time, reducing patient harm and improving the culture of patient safety have been national health care priorities. The study objectives were to describe the current state of patient safety in pediatric acute care settings and to assess whether modifiable features of organizations are associated with better safety culture. METHODS: An observational cross-sectional study used 2015-2016 survey data on 177 hospitals in four U.S. states, including pediatric care in general hospitals and freestanding children's hospitals. Pediatric registered nurses providing direct patient care assessed hospital safety and the clinical work environment. Safety was measured by items from the Agency for Healthcare Research and Quality's Culture of Patient Safety survey. Hospital clinical work environment was measured by the National Quality Forum-endorsed Practice Environment Scale. RESULTS: A total of 1875 pediatric nurses provided an assessment of safety in their hospitals. Sixty percent of pediatric nurses gave their hospitals less than an excellent grade on patient safety; significant variation across hospitals was observed. In the average hospital, 46% of nurses report that mistakes are held against them and 28% do not feel safe questioning authority regarding unsafe practices. Hospitals with better clinical work environments received better patient safety grades. CONCLUSIONS: The culture of patient safety varies across U.S. hospital pediatric settings. In better clinical work environments, nurses report more positive safety culture and higher safety grades.


Assuntos
Recursos Humanos de Enfermagem Hospitalar , Segurança do Paciente , Criança , Estudos Transversais , Hospitais Pediátricos , Humanos , Qualidade da Assistência à Saúde , Local de Trabalho
6.
J Pediatr Nurs ; 58: 36-38, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33310283

RESUMO

A notable challenge faced by pediatric hospitals during the COVID-19 pandemic included the need to decrease inpatient census and socially distant non-clinical hospital employees to alternative work arrangements. In doing so, nurses and other clinical care services employees were reassigned to new roles, while others continue to work from home. This paper aims to describe how during the COVID-19 pandemic, a pediatric hospital-based center for nursing research and evidence-based practice used this opportunity to virtually engage staff across the department in topics of clinical inquiry through education sessions, office hours, and individualized/team consultation. Therefore, elevating and increasing the presence of nursing research and evidence-based practice while providing opportunities for the continued professional development of nurses, respiratory therapists, clinical dietitians, child life specialists and employees in neurodiagnostics.


Assuntos
COVID-19 , Pesquisa em Enfermagem , Criança , Atenção à Saúde , Humanos , Pandemias/prevenção & controle , SARS-CoV-2
7.
Int Emerg Nurs ; 52: 100895, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32795958

RESUMO

INTRODUCTION: Emergency nurses are exposed to both primary and secondary trauma with attendant sequelae in both work and personal spheres. The purpose of the study was to investigate the prevalence of traumatic stress, measured by the secondary traumatic stress scale (STSS) in a sample of emergency nurses and describe the impact of traumatic stress on nursing practice and workplace environment. METHODS: Mixed methods approach using survey instrument data from the Secondary Traumatic Stress Scale (STSS) (N = 125) and focus group data (N = 53). RESULTS: The average total score on the STSS was 51.83 for nurses who attended one of the focus groups 48.42 for nurses who did not attend (clinical cutoff for STS = 39). Focus group data aligned with elements of the STSS; thematic categories of cumulative trauma, mental health sequelae, bullying and organizational violence, coping mechanisms, relationship damage, and solutions were described. Although we measured only STS, participants often used the terms "PTSD" and "STS" interchangeably. CONCLUSIONS: The nurses in this study demonstrated high levels of STS and described in detail how chronic, cumulative trauma affected relational nursing care and social connections. Participants discussed high levels of suicidality in the profession, and the compounding trauma of relational and organizational violence. The pervasiveness of traumatic stress and the extent to which it affects all areas of nurses' lives is a cause for great concern.


Assuntos
Enfermagem em Emergência , Serviço Hospitalar de Emergência , Recursos Humanos de Enfermagem Hospitalar/psicologia , Estresse Ocupacional/epidemiologia , Adaptação Psicológica , Adolescente , Adulto , Idoso , Bullying/psicologia , Feminino , Grupos Focais , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Violência no Trabalho/psicologia
8.
Hosp Pediatr ; 10(5): 408-414, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32253353

RESUMO

OBJECTIVES: The purpose of this study was to evaluate quality and safety of care in acute pediatric settings from the perspectives of nurses working at the bedside and to investigate hospital-level factors associated with more favorable quality and safety. METHODS: Using data from a large survey of registered nurses in 330 acute care hospitals, we described nurses' assessments of safety and quality of care in inpatient pediatric settings, including freestanding children's hospitals (FCHs) (n = 21) and general hospitals with pediatric units (n = 309). Multivariate logistic regression models were used to estimate the effects of being a FCH on favorable reports on safety and quality before and after adjusting for hospital-level and nurse characteristics and Magnet status. RESULTS: Nurses in FCHs were more likely to report favorably on quality and safety after we accounted for hospital-level and individual nurse characteristics; however, adjusting for a hospital's Magnet status rendered associations between FCHs and quality and safety insignificant. Nurses in Magnet hospitals were more likely to report favorably on quality and safety. CONCLUSIONS: Quality and safety of pediatric care remain uneven; however, the organizational attributes of Magnet hospitals explain, in large part, more favorable quality and safety in FCHs compared with pediatric units in general acute care hospitals. Modifiable features of the nurse work environment common to Magnet hospitals hold promise for improving quality and safety of care. Transforming nurse work environments to keep patients safe, as recommended by the National Academy of Medicine 20 years ago, remains an unfinished agenda in pediatric inpatient settings.


Assuntos
Hospitais Gerais , Hospitais Pediátricos , Recursos Humanos de Enfermagem Hospitalar , Qualidade da Assistência à Saúde , Criança , Estudos Transversais , Unidades Hospitalares , Humanos , Segurança do Paciente , Local de Trabalho
10.
Public Health Nurs ; 37(1): 5-15, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31452256

RESUMO

OBJECTIVE: To investigate changes in emergency nursing workload related to cannabis ingestion or inhalation by adult and pediatric patients in states and bordering states where recreational cannabis is legal. DESIGN: Qualitative exploratory design using data collected from focus groups. SAMPLE: Twenty-four English-speaking emergency nurses over the age of 18 who provide direct care to patients and work in US emergency departments located in a state, or bordering state, where recreational cannabis use is legal. MEASUREMENTS: Qualitative data were gathered using a semi-structured interview format and analyzed using situational analysis. RESULTS: The legalization of recreational cannabis in some US states is reported as resulting in an increase in patients presenting with cyclic vomiting syndromes, and increased difficulty in managing both associated behaviors and repetitive ED presentations. New presentations also include unintentional intoxication in both pediatric and geriatric populations. An unexpected finding was the displacement of local homeless populations by younger, indigent "cannabis tourists"; social services agencies might consider this while planning for cannabis legalization in their state or territory. CONCLUSIONS: To protect public health and safety, regulatory efforts to standardize the formulation, dosing and labeling of cannabis products would be beneficial along with educational initiatives for both consumers and health care providers.


Assuntos
Cannabis/toxicidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Legislação de Medicamentos , Recursos Humanos de Enfermagem Hospitalar/psicologia , Carga de Trabalho/estatística & dados numéricos , Adulto , Idoso , Criança , Enfermagem em Emergência , Feminino , Grupos Focais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Pesquisa Qualitativa , Estados Unidos , Vômito/induzido quimicamente , Vômito/enfermagem
11.
J Emerg Nurs ; 45(6): 614-621, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31537310

RESUMO

INTRODUCTION: Pediatric emergency nurses who are directly involved in clinical care are in key positions to identify the needs and concerns of patients and their families. The 2010 Institute of Medicine report on the future of nursing supports the active participation of nurses in the design and implementation of solutions to improve health outcomes. Although prior efforts have assessed the need for research education within the Pediatric Emergency Care Applied Research Network (PECARN), no systematic efforts have assessed nursing priorities for research in the pediatric ED setting. METHODS: The Delphi technique was used to reach consensus among emergency nurses in the PECARN network regarding research priorities for pediatric emergency care. The Delphi technique uses an iterative process by offering multiple rounds of data collection. Participants had the opportunity to provide feedback during each round of data collection with the goal of reaching consensus about clinical and workforce priorities. RESULTS: A total of 131 nurses participated in all 3 rounds of the survey. The participants represented the majority of the PECARN sites and all 4 regions of the United States. Through consensus 10 clinical and 8 workforce priorities were identified. DISCUSSION: The PECARN network provided an infrastructure to gain expert consensus from nurses on the most current priories that researchers should focus their efforts and resources. The results of the study will help inform further nursing research studies (for PECARN and otherwise) that address patient care and nursing practice issues for pediatric ED patients.


Assuntos
Técnica Delphi , Enfermagem em Emergência/métodos , Serviço Hospitalar de Emergência , Pesquisa em Enfermagem/métodos , Enfermagem Pediátrica/métodos , Criança , Feminino , Humanos , Masculino , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...